Lemon Bottle and Aqualyx fat dissolving injections:
what is actually known

What do Lemon Bottle and Aqualyx claim to contain?

The two products share a marketing category and little else.

Aqualyx

Aqualyx was developed in Italy by Pasquale Motolese and has been commercially available since 2009. It is described in the literature as a deoxycholate-based aqueous gel solution with saline and buffering compounds, injected into subcutaneous fat using a technique its maker calls intralipotherapy, in which longer needles are passed through the fat layer rather than a grid of shallow injections. The active principle is the same bile-acid detergent as the registered medicine deoxycholic acid: it disrupts the membrane of the fat cell and the body clears the debris. The difference is the vehicle, the concentration, the injection technique and, above all, the regulatory route.

Lemon Bottle

Lemon Bottle is made by Sid Medicos in Seoul. The packaging and marketing describe its main ingredients as riboflavin (vitamin B2), bromelain (an enzyme from pineapple) and lecithin, plus other plant-derived ingredients, and the maker has stated that it does not contain deoxycholic acid or phosphatidylcholine. The claim is that the blend speeds up fat-cell metabolism. None of those three ingredients has a recognised mechanism for destroying fat cells, and in 2024 Swissmedic's laboratory reported that the samples it tested did not match the declared contents and varied from pack to pack, with one sample containing caffeine and another containing none of the listed ingredients. The distributor subsequently said it could not verify that those samples were genuine and that the original ampoule is a cosmetic for external use rather than for injection.

One product is a deoxycholate taken down a device route; the other is a vitamin, enzyme and phospholipid blend that, by the maker's later statement, was not intended for injection at all.

How are they regulated, and what does that mean in Singapore?

Regulation is where the two products diverge most, and where the advertising is least clear.

In Singapore the framework is set by the Health Sciences Authority and the Singapore Medical Council. HSA assesses and registers therapeutic products and medical devices before they can be supplied, and has repeatedly warned that injectable aesthetic products sold online or supplied without a licence are illegal, with penalties under the Health Products Act. An injectable product cannot be sold as a cosmetic however it is labelled. The SMC's Guidelines on Aesthetic Practices for Doctors (2016 edition) set out which procedures a doctor may offer and note that mesotherapy, the injection of mixed lipolytic cocktails, is no longer permitted outside an approved clinical trial.

Any fat dissolving injection in Singapore should therefore answer three questions: what the product is, whether it is registered with HSA as a medicine or a device, and whether a registered medical practitioner is prescribing and injecting it. A product that cannot answer the second is not one a doctor here can supply, whatever its following overseas. The regulation of aesthetic medicine in Singapore page explains the framework in more detail.

“A product name is not an ingredient list, and a following is not a trial. Before anything goes under the skin I want to know what it is, who registered it, and whether the pocket is fat at all.”

Dr Sin YongOn Lemon Bottle and Aqualyx fat dissolving injections

What evidence exists for each?

The evidence falls into three tiers, and the marketing tends to borrow from the upper tier for products that sit in the lowest.

Registered deoxycholic acid. Two placebo-controlled phase 3 trials (REFINE-1 and REFINE-2) in adults with submental fullness, measured by clinician and patient scales, callipers and imaging, plus pooled safety data and a decade of post-marketing reports. The reaction pattern (swelling, bruising, numbness, firmness) and the uncommon risks (marginal mandibular nerve injury, difficulty swallowing, skin injury from superficial placement) are documented in the prescribing information.

Aqualyx. The device route did not require drug-style trials. The published literature consists of small series, mostly from a single group using ultrasound to guide and measure injections into small pockets such as the inner knee, together with case reports of complications. One 2022 report from a plastic surgery unit describes chronic infection, nodules and skin necrosis after a product advertised as Aqualyx was injected too superficially by an untrained injector. The mechanism is plausible because the active agent is a deoxycholate; the evidence that this particular formulation and technique are safe and effective across the areas it is marketed for is thin.

Lemon Bottle. No peer-reviewed clinical trial of efficacy or safety has been published. The claims rest on the maker's statements and on practitioner testimonials. The UK trade press reported in January 2024 that clinicians could find no clinical papers supporting its use, that a complaints register recorded a sharp rise in complaints about it in 2023, and that it was being advertised on social media at fees that suggested non-medical injectors. The Swissmedic laboratory findings in 2024 add a product-quality concern to the absence of efficacy data.

A plausible mechanism is not evidence. Deoxycholate has one; riboflavin, bromelain and lecithin do not, and even for deoxycholate the evidence is specific to a registered concentration and one anatomical site.

Why does a doctor assess the pocket before any injection?

Because the product is the last decision, not the first. Most of the people who ask about fat dissolving injections are describing a shape rather than a diagnosis, and the shape can be produced by several things.

• Under the chin, fullness can be submental fat, lax skin, the position of the platysma muscle, a short chin that makes a modest pad look larger, or a prominent submandibular gland. An injection that destroys fat helps the first and can worsen the second, and does nothing for the rest. The double chin treatment page sets out how the causes are separated.
• Along the jaw, a jowl can be a discrete fat pad or descended tissue; jowl fat versus sagging explains why the two need almost opposite treatment.
• On the body, a firm, rounded abdomen that does not pinch is visceral fat behind the muscle wall, which no injection or device reaches; a soft fold that pinches is subcutaneous fat, which is what contouring works on. The belly fat reduction page goes through the four non-surgical options and what none of them does.

Dr Sin Yong, an aesthetic physician on Orchard Road, Singapore, examines the area in person: a pinch test for fat, a tilt test for laxity, a look at projection and the gland, and ultrasound mapping to separate fat from filler where earlier filler is involved. The fat-directed methods on this site are fat freezing, Onda Pro and the 4K Body Lift; skin that has lost recoil is a question for the VF Lift – Vertical Facelift on Volnewmer, or on the body the VF Lift – Vertical Figure Lift. Where fat dissolving injections are discussed, they are discussed as the registered medicine deoxycholic acid, with its approved area and known reaction pattern, and their availability is confirmed at consultation.

Questions to ask before any fat dissolving injection

• What exactly is in the syringe, and can I see the product packaging and batch?
• Is it registered with HSA, and as a medicine or a medical device?
• Is a registered medical practitioner prescribing and injecting it, and has that practitioner examined the area in person?
• What is the evidence for this product at this site, rather than for fat dissolving in general?
• What is the expected reaction, and which uncommon risks apply to this area?
• What would you do if the fullness turns out to be skin, muscle, gland or bone rather than fat?

A clinic that can answer those in plain language is describing a medical treatment. A clinic that answers with a product name and a social media following is describing a trend. The glossary entry for deoxycholic acid explains the molecule behind the registered product, and how fees are quoted explains why fees here are set in writing after assessment rather than published by product.